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As Congress considers repealing the Affordable Care Act, health professionals in Kentucky, Ohio, and West Virginia grapple with what that might mean for a region where many depend on the law for access to care. This occasional series from the ReSource explores what’s ahead for the Ohio Valley after Obamacare. See more stories here >>

The Road To Recovery

On a recent gray winter morning, Tomas Green drove the rain-slicked streets of Ranson in West Virginia’s Eastern Panhandle. No matter the weather, Green helps transport clients working through addiction at the Jefferson Day Report Center get to their treatment sessions and meetings.

“If they need rides, I use my own personal transportation sometimes,” he said.

As a peer coach for the center, he strives to go above and beyond for the clients. Green can relate to his passengers: He’s in recovery himself.

His experience taught him recovery can be difficult. And now he wants to help others stay on the right path.

“For me, I share with everybody it’s good to have a good support system.”

Rebecca Kiger

On the road to the Day Report Center. Transportation to regular treatment sessions is important to addiction recovery.

But the support offered by the day report center faces an uncertain future as Congress considers repeal of the Affordable Care Act. Pending changes could have major consequences for the availability of substance abuse treatment in a region that has become the epicenter of the nation’s opioid addiction crisis.

Care Tied to the ACA

A lot of the funding tied to services offered by the day report center is tied to the ACA. And a repeal without replacement would be damaging.

“It would impact us negatively to the point where we would have to make tough decisions about the level of care that we could provide, even to the point where we might not be able to exist,” Executive Director Ronda Eddy said.

Day report centers work with non-violent drug offenders referred by the court system. They offer medication assisted treatment, counseling and other resources aimed at rehabilitation.

Local law enforcement has embraced this approach to dealing with addiction.

Charles Town Police Detective Ronald Kernes said the center is a valuable tool in the system, as they can’t arrest their way out of the epidemic.

“We understand that people have problems and addiction is a disease,” he said. “It’s nice to have an outlet where people at least have a chance to try to better themselves, and kick the habit and become a productive member of society.”

The day report center is in the infancy of offering services. They established the current facility just a few years ago.

Medicaid expansion under the ACA helped the center build on its early success.

“It certainly has expanded access to care, more behavioral health care, all of those things that support recovery,” Eddy said.

Expanding Treatment

Treatment centers across the Ohio Valley have used the additional resources in hopes of reducing the highest opioid addiction and overdose rates in the country.

Data from a Harvard/NYU study show that in Kentucky, Ohio, and West Virginia nearly 215,000 additional people were able to seek mental health and addiction treatment after the Medicaid expansion.

And that may be a low estimate. A report from Ohio’s Department of Medicaid claims their number is 50 percent higher than what researchers in the study found.

Rebecca Kiger

The waiting room at Jefferson Day Report Center in West Virginia.

Republican Congressional leaders are working to repeal the ACA but have yet to agree on its replacement. This is especially true for the ACA’s Medicaid expansion provisions; reform, reduction and elimination have all been proposed.

Cautionary Tales

In Portsmouth, Ohio, Lisa Roberts works with people struggling with addiction as a public health nurse for the city’s health department. Scioto County – where Portsmouth is located – has one of the highest rates of opioid addiction in the state.

The department offers Vivitrol shots to treat addiction and counseling to help with recovery. They refer individuals to other treatment programs if they are a better fit.

This program and others would be gone with a full repeal of the ACA, according to Roberts.

“There would be people who lose access to their Vivitrol injections, a lot of people that would lose access to their addiction treatment,” she said. “It could just be catastrophic.”

Portsmouth, Ohio, public health nurse Lisa Roberts saw what happens when addiction treatment abruptly ends. “It could just be catastrophic.”

Roberts has two examples of what happens when treatment is suddenly lost: one professional and one personal.

Federal and state authorities shut down Community Counseling and Treatment Services, an opiate treatment practice operating in Scioto and Lawrence counties, on Sept. 25, 2014, during an investigation into Medicaid fraud and other allegations. No charges have been filed and no arrests made in the investigation, but Community Counseling and Treatment Services was never again permitted to accept Medicaid and remains closed.

That forced Roberts and the Portsmouth Health Department to scramble to quickly find clinics that would accept Medicaid for around 1,200 people who suddenly lost treatment.

“We had to triage. We had to prioritize people,” Roberts said.

Other local facilities were overwhelmed and some people had to travel up to 100 miles for treatment. Long trips proved difficult for those who lacked the transportation or the time.

Some relapsed and had to resume treatment later. Others didn’t make it.

“We did experience a spike in overdoses and we also experienced a lot of fatal overdoses,” Roberts said. “It was actually the most lethal month that we’ve seen in Scioto County.”

Scioto County had no more than three accidental fatal overdoses in a month until October, right after the clinic closed, when they had six.

Close to Home

Roberts’ personal experience with the loss of coverage for addiction treatment came as part of her daughter’s struggle with addiction.

Vivitrol injections were what helped Roberts’ daughter sustain recovery. And she was covered under the Medicaid expansion.

But when her daughter moved to Tennessee — a state that did not expand Medicaid — she suddenly lost access to the shots. Roberts stepped in.

“I would have to drive 400 miles to give her that injection,” she said. “And eventually she was able to get it there through the Affordable Care Act.”

Her daughter later returned to Ohio and continues recovery. But Roberts understands that others may not be as fortunate. She says the lessons for the ACA debate remain the same even if the circumstances of her experiences are different.

She and others fear repealing the ACA without a replacement could trigger a wave of similar events across the Ohio Valley.

Waiting and Working

As Congress continues its health care debate, the people Tomas Green drives to the West Virginia treatment center wait to see what will happen to their coverage.

To Green and others on the road to recovery, the journey is already a difficult one. But he says it comes with rewards.